Adapting psychedelic medicine for headache and chronic pain disorders.

Most current psychedelic research targets depression and substance use disorders, but reports also indicate benefits for headache disorders and chronic pain. This perspective reviews conventional treatments for these conditions and describes historical, recent, and ongoing investigations of psychedelics' therapeutic effects, including the first two clinical trials of psilocybin in headache disorders and case reports of psilocybin mushroom self-administration in chronic pain patients. It highlights challenges when applying the standard psychedelic-assisted psychotherapy model—featuring larger doses, emphasis on subjective effects, and required adjunctive psychotherapy—to headache and chronic pain disorders. Flexibility in protocols is needed to evaluate different treatment paradigms and mechanisms.

Study at a glance

Abstract

While the majority of current research and development surrounds depression, demoralization, and substance use disorders, there are numerous reports of psychedelics having beneficial effects in other branches of medicine, including for headache disorders and chronic pain. This perspective reviews conventional forms of treatment for headache and other chronic pain disorders and describes historical, recent, and ongoing investigations of the therapeutic effects of psychedelics in these disorders. The first two clinical trials of psilocybin in headache disorders and recent case reports of psilocybin mushroom self-administration in chronic pain patients are described. This perspective highlights several factors related to the application of psychedelics in chronic pain disorders, comparing this with the standard psychedelic-assisted psychotherapy model of treatment. When faced with a more constricted view of psychedelic medicine that features larger doses, underscores subjective effects in the mediation of therapeutic outcomes, and requires adjunctive psychotherapy to ensure safety and efficacy, the application of psychedelics in headache and chronic pain disorders may face challenges. It will be important to allow for flexibility and adaptation in protocols to evaluate different treatment paradigms, mechanisms of action, and the range of pharmacologic and extra-pharmacologic factors that affect psychedelic treatment outcomes.